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    Eating Disorders

    All About Bulimia Nervosa

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    All About Bulimia Nervosa

    While bulimia is commonly recognized by its characteristic symptoms of bingeing and purging, it encompasses more than just these behaviors.

    The disorder is also characterized by compulsive thoughts about food, weight, body image, and shape. However, with proper treatment and effective coping mechanisms, individuals with bulimia can successfully manage the disorder.

    It is important to understand the full range of symptoms associated with the disorder to effectively identify and address it.

    What is bulimia?

    Bulimia is an eating disorder that is associated with harmful and extreme eating patterns. It is often characterized by episodes of binge eating, where individuals consume large amounts of food in a short period of time and feel like they cannot control their eating.

    This is often followed by feelings of guilt and shame, leading to purging behaviors to get rid of the food consumed.

    But there are actually two types of bulimia: purging and non-purging.

    • Purging bulimia. Purging bulimia is the more common type, where individuals use methods such as vomiting, laxatives, or diuretics to rid their bodies of the calories consumed during a binge
    • Non-purging bulimia. Non-purging bulimia, on the other hand, involves compensating for binge eating by fasting or engaging in excessive exercise.

    Individuals with bulimia may display both purging and non-purging behaviors.

    The behaviors associated with bulimia often occur in secrecy, leading those with the condition to feel isolated and alone. However, bulimia is not a rare disorder, and many individuals struggle with it.

    Approximately 28.8 million Americans will experience an eating disorder at some point in their lives, with around 288,000 individuals, or 1%, having bulimia nervosa.

    Statistics of bulimia

    Contrary to common beliefs and media portrayals, bulimia does not only impact young, Caucasian women. People of all ages, genders, sexual orientations, races, and body sizes can develop the condition.

    Let us briefly examine some statistics regarding bulimia and the people it impacts.

     

    • Around 1% of individuals in the United States will experience bulimia nervosa during their lifetime.
    • Bulimia is more prevalent in females, with 0.5% of females affected, which is 5 times more than the prevalence in males (0.1%).
    • The proportion of females seeking treatment for bulimia is higher compared to males.
    • The typical age at which bulimia starts is 18 years old.
    • 41.3% of adolescents with bulimia report engaging in purging behaviors, while the rest exhibit non-purging behaviors.
    • To engage in bulimia-related behaviors, such as bingeing and purging, black teenagers are 50% more likely than white teenagers.
    • Hispanic individuals have a higher prevalence of bulimia compared to non-Hispanic individuals
    • Asian American college students have higher rates of bulimia-related behaviors such as purging compared to their non-Asian counterparts.
    • Gay men have a higher likelihood of binge eating and purging than heterosexual men, with reports indicating that they are 7 times more likely to binge eat and 12 times more likely to purge.
    • Gay and bisexual boys have a higher likelihood of engaging in purging behaviors like vomiting, fasting, or using laxatives or diet pills to manage their weight.
    • Bulimia-related behaviors, including self-induced vomiting, using diet pills or laxatives, are engaged in by approximately 35 to 57% of adolescent girls.
    • The prevalence of bulimia is higher than other eating disorders among military members.

    Signs and symptoms

    Identifying bulimia in a person by their appearance may not always be accurate. Individuals with bulimia may have any body weight – underweight, normal weight, or overweight. However, there are some physical signs that may indicate the presence of bulimia.

    These include:

    • Swelling of cheeks or jaws
    • Severe dehydration
    • Scrapes or calluses on the knuckles or back of hands
    • Gastrointestinal problems such as acid reflux or constipation
    • Broken blood vessels in the eyes
    • Discolored or stained teeth.

    Individuals with bulimia often conceal their symptoms, but there are some behaviors you can observe that may indicate a problem. These common behaviors or changes may include:

    • Immediately going to the bathroom after eating.
    • Finding empty food wrappers in unexpected places.
    • Exercising excessively, even in bad weather or when tired or injured.
    • Hoarding food in strange places.
    • Discovering empty packages of laxatives, diuretics, or diet pills.
    • Skipping meals or eating much smaller portions.
    • Excessively using mouthwash, mints, or gums.

    Causes and risk factors

    Although the exact cause of bulimia is not completely understood, several factors are believed to increase a person’s likelihood of developing this eating disorder.

    These factors include genetics, emotional distress, mental health conditions, societal and cultural experiences, stressful life events, bullying and weight shaming, and traumatic events.

    There is still much to uncover regarding the root causes of bulimia. One area of interest for researchers is investigating how changes in brain structure may be linked to disordered eating behaviors.

    Diagnosis

    If you suspect that you have bulimia or another eating disorder, you can begin by consulting a healthcare professional who can perform an assessment, diagnose, or refer you to an eating disorder specialist.

    Your doctor will likely begin with a physical exam, which may include an assessment of your weight and height to determine your body mass index (BMI).

    They will also review your medical history to look for any significant changes in weight over time. You will also be questioned about your eating and exercise habits and will likely be asked to complete a mental health questionnaire.

    A blood test may also be performed to rule out any other conditions that may be causing or related to your symptoms. Ultimately, a diagnosis of bulimia is usually based on meeting the criteria outlined in the diagnostic and statistical manual of mental disorders.

    Identifying bulimia can be challenging, as individuals who exhibit bulimia-related behaviors may not meet all of the diagnostic criteria.

    According to a 2018 study, a much higher percentage of people (14 to 22%) display eating disorder behaviors than those who meet the strict diagnostic criteria (less than 2%). Therefore, diagnosing bulimia requires a comprehensive evaluation by a healthcare professional.

    To add, individuals from marginalized communities, including Black, Indigenous, and People of Color, are less likely to receive a diagnosis for an eating disorder compared to white individuals. However, it’s important to note that everyone deserves access to support and treatment, regardless of whether they meet strict diagnostic criteria or not.

    Treatment

    There are multiple approaches to treating and managing bulimia, and the treatment plan is tailored to each individual’s needs. Since every person with bulimia has unique circumstances, no two treatment plans will be identical.

    To manage bulimia, different treatments are available, and a combination of them is often used. Each individual’s treatment plan is unique and tailored to their specific needs since people with bulimia can present different symptoms and situations.

    Treatment options may include individual, group or family psychotherapy, cognitive-behavioral therapy, inpatient or outpatient rehabilitation, nutritional therapy, medication, nutritional counseling, or support groups.

    The duration of treatment varies from person to person, and some may recover after the first treatment while others may require additional treatment if they experience a relapse.

    Although bulimia can be a lifelong condition, treatment can help individuals develop a healthier relationship with food and exercise.

    Complications

    Repeated episodes of bingeing and purging associated with bulimia can lead to various complications that can affect the body’s overall health, particularly the heart and other bodily functions. These complications can develop over time.

    Toxins and deficiencies caused by long-term purging cycles in bulimia can have damaging effects on the body, leading to various complications.

    Some common complications include an inflamed esophagus, ulcers, pancreatitis, tooth decay, inflamed glands in the jaw and cheeks, anemia, irregular heartbeat, heart failure, kidney failure, and malnutrition.

    In severe cases, these complications can be life-threatening, leading to organ failure or death.

    Other conditions

    People with eating disorders often have coexisting mental health conditions.

    Individuals who suffer from eating disorders frequently experience concurrent mental health conditions. The National Institute of Mental Health reports that 94.5% of people with bulimia have at least one other coexisting mental health condition.

    It has been suggested by research that individuals with bulimia may be more likely to engage in self-harming behaviors, like cutting, at a rate of 30-40%.

    Living with bulimia

    Recovering from bulimia can be a challenging process that requires a lot of effort. It can be difficult to reestablish healthy eating habits and develop coping mechanisms.

    Full recovery can take several months or even years, and relapses can occur along the way.

    Recovery can’t fully begin until you’ve experienced:

    • Physical recovery: In order to start the recovery process, it’s important to be in good physical health and maintain a healthy weight that’s appropriate for your body.
    • Behavioral recovery: Reducing or eliminating bulimia-related behaviors, such as bingeing and purging or non-purging.
    • Psychological recovery: Having a realistic image of your body weight and shape, and having healthy goals.

    Having a reliable support system is essential for recovery. Support from family, friends, and healthcare providers can encourage positive eating behaviors and provide a listening ear when needed. It is possible to significantly reduce symptoms of bulimia with treatment, even if complete recovery is not yet achieved.

    Continued management over time can lead to the elimination of all symptoms.

    Getting help

    Admitting to having bulimia can be intimidating for some individuals, but it’s crucial to seek assistance as soon as possible.

    If left untreated, bulimia can lead to severe damage to the body. Assistance is obtainable, and it’s essential to communicate with a healthcare provider or eating disorder specialist. You can discuss your emotions, ideas, and symptoms with them.

    If you’re worried about a loved one, your support and encouragement can be a significant help. Although you can’t compel someone with bulimia to seek help, being present for them and showing them that you care can be invaluable.

    If you want to connect with others who are also living with bulimia, you can find community forums and more at the National Eating Disorders Association.

    If you want to find a local treatment center near you, you can find that information here.

    Other organizations where you can find help include:

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